Why do city kids have higher rates of psychosis?

While a small minority of children overall experience persistent psychotic symptoms and eventual clinical diagnosis, those numbers are higher in cities.

Psychotic symptoms include paranoid thoughts, hearing or seeing things that others do not, and believing others can read one’s mind. Children who experience these psychotic experiences may be at higher risk for schizophrenia and other psychiatric disorders as adults.

A new study of British twins suggests a lack of social cohesion and crime may play a role.

“We wanted to understand how the communities children live in are affecting them,” says Candice Odgers, associate professor of psychology and public policy at Duke University and senior associate director at the Center for Child and Family Policy. “This study helps us identify specific features of neighborhoods that may be especially toxic for children’s mental health.”

The study, published in Schizophrenia Bulletin, followed 2,232 British twins from birth to age 12. Children’s psychotic symptoms at age 12 were assessed through in-home interviews.

Neighborhood features were captured by surveying local residents and constructing high-resolution geospatial profiles from administrative records and Google Street View images. The study controls for family history of mental illness and for the mother’s history of psychotic symptoms.

“We brought together our best measures of children’s mental health with innovations in geospatial assessments to test why children growing up in urban environments are at heightened risk for psychotic experiences,” Odgers says.

Vigilance and paranoia

The researchers found that 12-year-olds in urban neighborhoods were almost twice as likely to experience a psychotic symptom than those in non-urban areas. This held true when controlling for residential mobility, social-economic status, and family psychiatric history. Around 7.4 percent of children living in urban areas had experienced at least one psychotic symptom by age 12, compared to 4.4 percent living in non-urban areas.

“Just because a child experiences a psychotic symptom does not mean he or she will develop full-blown mental health disorders,” says Helen Fisher, senior lecturer and fellow at King’s College London. “Many children grow out of them, but these unusual early experiences can lead to a range of problems later.”

The researchers looked at four experiences at the neighborhood level to help determine the cause:

Supportiveness and cohesiveness between neighbors

The likelihood that neighbors would intervene if problems occurred in the neighborhood

Disorder in the neighborhood, such as graffiti, vandalism, noisy neighbors, loud arguments

Crime victimization.

Psychotic symptoms were more common in children who lived in areas with low social cohesion, low social control, and high neighborhood disorder and whose family had been the victim of a crime.

But low social cohesion and crime victimization seemed to have the largest impact. That combination of factors explained a quarter of the association between urban living and psychotic symptoms in children.

“One of the encouraging findings is that social cohesion is changeable at the community level.”

The study could be used in developing social and clinical interventions for early psychotic symptoms to reduce costly mental health problems later down the line, researchers say. “One of the encouraging findings is that social cohesion is changeable at the community level and not entirely dependent on economic resources,” Odgers says. “Many of the most cohesive neighborhoods in our study were also the most economically deprived.”

Since childhood psychotic symptoms are relatively rare, with less than 6 percent of children in the study reporting them, the researchers recommend the study be replicated. Further research is also needed to better understand psychotic symptoms in later adolescence.

The exact nature of the effect of urban neighborhoods on childhood psychotic symptoms is now important to uncover, says lead author Joanne Newbury, a PhD student at King’s College London.

“Do crime and threat increase children’s vigilance and paranoia?” Newbury says. “Does prolonged exposure to neighborhood stressors undermine some children’s ability to cope with stressful experiences? Further research is needed to identify the social and biological mechanisms underlying our findings.”

This text is published here under a Creative Commons License.
Author: Amy Dominello Braun-Duke University
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